Liver Cirrhosis - Supplements

Get added support for this serious disease by taking care of your nutritional needs. According to research or other evidence, the following self-care steps may be helpful.

Stop drinking
Head off additional liver damage by avoiding alcohol
Balance protein and amino acids
Work with a knowledgeable health professional to determine that amount of protein or specific amino acids that will meet your daily needs without overtaxing your liver
Discover SAMe
Taking 1,200 mg a day of this nutritional supplement can improve liver function, bile flow, and survival
Try milk thistle
Protect liver cells and improve function by taking a daily herbal supplement delivering 420 to 600 mg of silymarin
Get to know phosphatidylcholine
Take 900 mg a day of this nutritional supplement to improve liver function

Also indexed as:

cirrhosis,
cirrhosis of the liver,
hepatic cirrhosis,
liver cirrhosis

About this treatment

What Are "Star" Ratings?

a7_3star Reliable and relatively consistent scientific data showing a substantial health benefit.

a7_2star Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

a7_1star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

Supplement	Amount	Why
SAMe	1,200 mg daily	Taking SAMe may improve liver function, bile flow, and survival.
SAMe 1,200 mg daily Large amounts of SAMe (S-adenosylmethionine) may improve survival and liver function in alcoholic liver cirrhosis. A double-blind trial found that 1,200 mg of SAMe per day for two years significantly decreased the overall death rate and the need for liver transplantation in people with alcoholic liver cirrhosis, particularly in those with less advanced liver disease.⁷ Preliminary trials suggest that lower amounts of SAMe (180 mg per day in one trial⁸ and 800 mg per day in another⁹) may improve liver function in people with liver cirrhosis. SAMe supplementation has been shown to reverse the depletion of glutathione, an important antioxidant required for liver function.¹⁰It has also been shown to aid in the resolution of blocked bile flow (cholestasis), a common complication of liver cirrhosis.¹¹ ^{, 12} What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Acetyl-L-Carnitine	2 grams twice a day for 3 months	A double-blind trial suggests that supplementing with acety-l-carnitine may improve mental and neurological function in people whose cirrhosis has impaired function.
Acetyl-L-Carnitine 2 grams twice a day for 3 months In a double-blind trial, supplementation with acety-l-carnitine (2 grams twice a day for three months) improved various measures of mental and neurological function in people with impaired function (minimal hepatic encephalopathy) due to cirrhosis.¹³ What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Beta-Glucan, Inulin, Pectin, and Resistant Starch	10 grams total fermentable fiber daily	In a study of people with cirrhosis, supplementing with fermentable fiber (containing equal parts of beta-glucan, inulin, pectin, and resistant starch) improved liver and brain function.
Beta-Glucan, Inulin, Pectin, and Resistant Starch 10 grams total fermentable fiber daily In a study of people with cirrhosis, supplementing with 10 grams of fermentable fiber per day (containing equal parts of beta-glucan, inulin, pectin, and resistant starch) for 30 days resulted in an improvement in liver function.¹⁴ The impaired brain function that often accompanies cirrhosis of the liver (hepatic encephalopathy) also improved.

Supplement	Amount	Why
Branched-Chain Amino Acids	At least 5 grams daily, up to 0.24 grams per 2.2 lbs (1 kg) body weight per day	Under a doctor’s supervision, supplementing with branched-chain amino acids may correct an imbalance of amino acids and improve cirrhosis symptoms.
Branched-Chain Amino Acids At least 5 grams daily, up to 0.24 grams per 2.2 lbs (1 kg) body weight per day In addition to protein deficiency, liver cirrhosis is characterized by low blood levels of branched-chain amino acids (BCAAs) in relation to other amino acids.¹⁵ This imbalance may contribute to the development of PSE.¹⁶ BCAA supplementation could be a way to correct this problem, as well as to provide a source of needed protein, but its effectiveness is unclear.¹⁷ BCAAs (isoleucine, leucine, and valine) represent a good protein source for people with cirrhosis because they are less likely to induce PSE. A controlled study of protein-intolerant people with cirrhosis showed that BCAA supplementation corrected abnormal protein metabolism about as well as an equivalent amount of dietary protein without inducing PSE as frequently.¹⁸ In a small double-blind trial, people with liver cirrhosis taking 5 grams per day of BCAAs had significant improvement in their ability to process protein.¹⁹ However, treatment trials using BCAAs alone or in solutions containing other amino acids in people with cirrhosis and PSE have reported conflicting results.²⁰ ^{, 21} ^{, 22} ^{, 23} It may be that certain people with liver cirrhosis can benefit from supplementation with BCAAs while others cannot, for reasons that are unclear.²⁴ In a double-blind trial, people with liver cirrhosis and PSE received 0.24 grams per 2.2 pounds body weight (approximately 16–17 grams per day) of BCAAs for 15 days, after which most experienced significant improvement in brain function, mental status, and protein metabolism. Those who continued taking BCAAs for three months also had mild improvement in liver function tests.²⁵ Therapeutic effects of oral BCAAs have also been shown in children with liver failure²⁶ and in adults with cirrhosis of the liver without PSE.²⁷ Overall, it appears that BCAA supplementation does not always help in cirrhosis, but some people with and without PSE may benefit. A qualified doctor must closely supervise such BCAA supplementation. What Else Is This Supplement Used For?

Supplement	Amount	Why
Liv-52	1 tablet three times per day	Liv-52, an herbal preparation used in traditional Indian medicine to treat various liver disorders, has been reported to have antioxidant, anti-inflammatory, and diuretic effects.
L-Ornithine-L-Aspartate	18 grams daily of L-ornithine-L-aspartate	As both a supplement and injection, L-ornithine-L-aspartate has been shown to significantly improve liver function, mental status, and brain function.
L-Ornithine-L-Aspartate 18 grams daily of L-ornithine-L-aspartate L-ornithine-L-aspartate (OA) is a nutritional supplement that has been investigated as a treatment for cirrhosis and hepatic encephalopathy. In a double-blind trial, participants taking 18 grams of OA for 14 days had significant improvements in liver function, mental status, and brain function.²⁸ Similar benefits have also been demonstrated using injections of OA.²⁹^{, 30}

Supplement	Amount	Why
Milk Thistle	420 mg of silymarin daily	Supplementing with milk thistle may protect liver cells and improve function.
Milk Thistle 420 mg of silymarin daily An extract of milk thistle (Silybum marianum) that is high in a flavonoid compound known as silymarin may improve liver function and increase survival in people with cirrhosis. Clinical trials have shown that silymarin (420–600 mg per day) improves liver function tests and protects liver cells against oxidative damage in people with alcohol-related liver disease.³¹ ^{, 32} ^{, 33} ^{, 34} However, evidence is conflicting regarding the ability of silymarin to prolong survival of people with liver cirrhosis. In one double-blind trial, a significant increase in survival was found in people with cirrhosis who were given 140 mg of silymarin three times a day for approximately two years.³⁵ Positive results were also found in a 12-month controlled study of adults with diabetes and alcoholic liver cirrhosis taking the same daily amount of silymarin.³⁶ However, another double-blind trial found that 150 mg of silymarin three times a day for two years had no significant effect on survival among alcoholics with liver cirrhosis.³⁷ For people with chronic liver disease, milk thistle extract may be taken long-term. Milk thistle extracts containing 80% silymarin are commercially available and may be taken in amounts that deliver 420 mg of silymarin per day. What Else Is This Supplement Used For?

Supplement	Amount	Why
Peony	Under medical supervision: take the Chinese herbal formula shakuyaku-kanzo-to	One trial showed that the Chinese formula shakuyaku-kanzo-to (containing white peony and licorice roots) relieved muscle cramps due to liver cirrhosis.
Peony Under medical supervision: take the Chinese herbal formula shakuyaku-kanzo-to One double-blind trial showed that the Chinese formula shakuyaku-kanzo-to (containing white peony and licorice roots) effectively relieved muscle cramps due to cirrhosis of the liver.³⁸ This formula is approved by the Japanese Ministry of Health and Welfare for cirrhosis-induced muscle cramps. What Else Is This Supplement Used For?

Supplement	Amount	Why
Phosphatidyl Choline	900 mg phosphatidyl choline per day	Phosphatidylcholine breaks down scar tissue in the liver and may be able to reverse tissue changes that cause cirrhosis.
Phosphatidyl Choline 900 mg phosphatidyl choline per day Phosphatidylcholine (PC) breaks down scar tissue in the liver and may be able to reverse tissue changes that cause cirrhosis.³⁹ In animal studies, PC has been repeatedly shown to prevent or reverse the progression of alcohol-induced cirrhosis,⁴⁰^{, 41}^{, 42} but this has not yet been demonstrated in humans. In a controlled trial, Czech researchers found that PC supplementation (900 mg per day for four months) improved liver function in people with cirrhosis.⁴³

Supplement	Amount	Why
Sho-Saiko-To (Bupleurum, Peony, Pinellia, Cassia, Ginger, Jujube, Asian Ginseng, Asian Scullcap, and Licorice)	2.5 grams of the Chinese herbal formula sho-saiko-to three times daily	The Chinese herb bupleurum is a component of the formula sho-saiko-to, which was shown in one preliminary trial to liver cancer risk in people with liver cirrhosis.
Sho-Saiko-To (Bupleurum, Peony, Pinellia, Cassia, Ginger, Jujube, Asian Ginseng, Asian Scullcap, and Licorice) 2.5 grams of the Chinese herbal formula sho-saiko-to three times daily The Chinese herb bupleurum is an important component of the formula known as sho-saiko-to. Sho-saiko-to was shown in one preliminary trial to reduce the risk of liver cancer in people with liver cirrhosis.⁴⁴ The amount of this formula used was 2.5 grams three times daily.

Supplement	Amount	Why
Zinc (Zinc Deficiency)	Take under medical supervision: 135 to 215 mg daily	Supplementing with zinc may correct the deficiency common in alcoholic liver cirrhosis and may correct the impaired taste function that people with cirrhosis often experience.
Zinc Take under medical supervision: 135 to 215 mg daily Alcoholic liver cirrhosis is associated with zinc deficiency.⁴⁵ ^{, 46} In a double-blind trial, zinc acetate supplementation (200 mg three times daily, providing a total of 215 mg of elemental zinc per day), given to cirrhosis patients for seven days, significantly improved portal-systemic encephalopathy (PSE).⁴⁷ A second trial achieved similar results after three months of treatment.⁴⁸ People with cirrhosis sometimes have impaired taste function, and it has been suggested that zinc deficiency may be the cause of this abnormality. Although one study demonstrated that taste problems in cirrhosis are due to the disease process itself and not to zinc deficiency,⁴⁹ a double-blind trial showed that 200 mg three times per day of zinc sulfate (providing 135 mg of elemental zinc per day) for six weeks significantly improved taste function in people with alcoholic liver cirrhosis.⁵⁰ A doctor should supervise long-term supplementation of zinc in these amounts. What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Bile Acids (Primary Biliary Cirrhosis)	Refer to label instructions	People with cirrhosis have decreased secretion of bile acids. Supplementing with bile acids may improve bile composition and delay disease progression in primary biliary cirrhosis.
Bile Acids People with cirrhosis have decreased secretion of bile acids.⁵¹ Supplementation with bile acids (such as ursodeoxycholic acid and tauroursodeoxycholic acid) may improve the composition of bile and delay disease progression in primary biliary cirrhosis (PBC). In one trial, people with PBC were followed for five to nine years. Those who took 13–15 mg per 2.2 pounds body weight of ursodeoxycholic acid (about 900–1200 mg) per day had improved liver function tests and significantly delayed progression to cirrhosis.⁵² Several other trials have confirmed that bile acids improve liver function in people with PBC.⁵³ ^{, 54} ^{, 55} ^{, 56} ^{, 57} Commercial supplements of bile acids are available as ox bile concentrates. However, these ox bile preparations contain other types of bile acids than those used in PBC research. The effectiveness and appropriate amount of ox bile concentrates in the treatment of PBC is unknown.

Supplement	Amount	Why
L-Carnitine	Refer to label instructions	L-carnitine injections have been used to improve circulation to the liver in people with cirrhosis.
L-Carnitine L-carnitine injections have been used to improve circulation to the liver in people with cirrhosis,⁵⁸ but trials of the oral supplement are lacking. What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Selenium	Refer to label instructions	People with liver cirrhosis often have low selenium levels and a greater need for antioxidants. In one study, selenium improved liver function in people with alcoholic cirrhosis.
Selenium Selenium levels have been found to be low in people with liver cirrhosis⁵⁹ and the need for antioxidants has been found to be increased.⁶⁰ A small, preliminary trial suggested that 100 mcg per day of selenium may improve liver function in people with alcoholic cirrhosis.⁶¹ Larger, double-blind trials of selenium in people with liver cirrhosis are needed. What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Vitamin E	Refer to label instructions	Vitamin E has been shown to decrease damage in cirrhotic livers and may reduce immune abnormalities that contribute to the development of the disease.
Vitamin E Vitamin E has been shown to decrease damage in cirrhotic livers and may reduce immune abnormalities that contribute to the development of the disease.⁶² However, a study reported that supplementation of 500 IU per day of vitamin E for one year failed to influence laboratory tests, liver function, survival or hospitalization rates in people with alcoholic cirrhosis.⁶³ Further clinical trials are needed to determine if any benefits may be expected from vitamin E supplementation in people with liver cirrhosis. What Else Is This Supplement Used For? See Drug Interactions

References

Last Review: 05-11-2011

Learn more about Aisle7, the company.

The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires June 2011.

© 1995-2011 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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